We’ve a new study appearing in the BMC Journal that pretty much confirms the polling we’ve seen over the past couple of years on the willingness of HCWs (Health Care Workers) to work during a severe pandemic.
In a severe pandemic – unlike novel H1N1 – the mortality rate would likely approach or perhaps even exceed that seen during the 1918 Spanish Flu.
All along, government planners have assumed that up to 40% of HCWs might be absent due to illness or staying home to care for ill family members.
There is another category of absenteeism which is less commonly discussed; the unwillingness of some HCWs to report for work in a pandemic.
First a look at the abstract to today’s study (slightly reformatted for readability-emphasis mine), which was conducted before the outbreak of novel H1N1, then I’ll return with some additional comments.
Characterizing hospital workers' willingness to report to duty in an influenza pandemic through threat- and efficacy-based assessment
Ran D Balicer , Daniel J Barnett , Carol B. Thompson , Edbert B. Hsu , Christina L. Catlett , Christopher M. Watson , Natalie L. Semon , Howard S Gwon and Jonathan M. Links
BMC Public Health 2010, 10:436doi:10.1186/1471-2458-10-436
Published: 26 July 2010
Hospital-based providers' willingness to report to work during an influenza pandemic is a critical yet under-studied phenomenon. Witte's Extended Parallel Process Model (EPPM) has been shown to be useful for understanding adaptive behavior of public health workers to an unknown risk, and thus offers a framework for examining scenario-specific willingness to respond among hospital staff.
We administered an anonymous online EPPM-based survey about attitudes/beliefs toward emergency response, to all 18,612 employees of the Johns Hopkins Hospital from January to March 2009. Responses were received from 3426 employees (18.4%), approximately one third of whom were health professionals.
Demographic and professional distribution of respondents was similar to all hospital staff. Overall, more than one-in-four (28%) hospital workers indicated they were not willing to respond to an influenza pandemic scenario if asked but not required to do so. Only an additional 10% were willing if required. One-third (32%) of participants reported they would be unwilling to respond in the event of a more severe pandemic influenza scenario.
These response rates were consistent across different departments, and were one-third lower among nurses as compared with physicians. Respondents who were hesitant to agree to work additional hours when required were 17 times more likely to be unwilling to respond during a pandemic if asked. Sixty percent of the workers perceived their peers as likely to report to work in such an emergency, and were ten times more likely than others to do so themselves. Hospital employees with a perception of high efficacy had 5.8 times higher declared rates of willingness to respond to an influenza pandemic.
Significant gaps exist in hospital workers' willingness to respond, and the EPPM is a useful framework to assess these gaps. Several attitudinal indicators can help to identify hospital employees unlikely to respond.
The findings point to certain hospital-based communication and training strategies to boost employees' response willingness, including promoting pre-event plans for home-based dependents; ensuring adequate supplies of personal protective equipment, vaccines and antiviral drugs for all hospital employees; and establishing a subjective norm of awareness and preparedness.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
According to this study, 1/3rd of HCWs would be unwilling to work during a severe pandemic, which corresponds pretty closely to other studies we’ve seen.
Lest anyone think working at a hospital or clinic during a severe pandemic would be an easy decision, the hospital worker would be not only repeatedly exposing themselves to the virus, many would also be exposing their families by proxy.
Vaccines, antivirals, and even PPEs (Personal Protective Equipment) may be in short supply (or non-existent), and there may be hospital security issues as well. Some HCWs fear being `locked down’ or quarantined at their facility and unable to go home and care for their own families.
And given the expected absenteeism levels and the high rate of admissions, the burden on the remaining staff would be enormous.
And it isn’t just doctors, nurses, and techs.
Non-medical employees such as housekeeping, food service, laundry, security, lab, and even clerical workers are vitally important, and few facilities could operate for very long without them.
You’ll find results from similar surveys taken in 2008 and 2009 in the following blogs entries.
Since April of 2008 the Allnurses.com forum has been conducting an online poll - asking if nurses would work without full protective PPE's (Personal Protective Equipment - masks, gowns, gloves, etc.) during a `bird flu’ pandemic.
Prior to the outbreak of novel H1N1, the percentage of respondents saying they would not report for work was roughly 30%, with another 20% undecided.
In the wake of our current (relatively mild) pandemic, the percentage of those unwilling to work has dropped to just under 22%, with nearly 15% undecided.
The vigorous debate in the comments thread should be required reading for every hospital pandemic coordinator.
As this latest study and many of the comments on the allnurses.com thread point out, addressing employee concerns over the availability of antivirals, PPEs, and vaccines - along with visibly planning for the safety of employees and their families – are critical steps necessary if hospitals hope to retain much of their staff during a severe pandemic.
Steps that few hospitals, right now, appear to be taking.